What Is Menopause?

Menopause is a natural biological process that causes menstruation to end. This process occurs when people who menstruate stop making the reproductive hormones their body needs to ovulate and menstruate each month.

Generally, people who menstruate undergo the phases of menopause between the ages of 45 and 55. During this time, it's normal to experience a wide variety of symptoms including hot flashes, poor sleep, mood swings, and vaginal dryness. You can’t cure menopause or prevent the process from occurring, but you can reduce the symptoms and side effects with proper treatment.

Stages of Menopause 

Menopause can be grouped into three main phases: perimenopause, menopause, and postmenopause.

Perimenopause 

This is the transition phase into menopause, which can start four to eight years before you stop getting your period. Your cycle length begins to change and other symptoms, like hot flashes and insomnia, start to occur.

Menopause 

Once you have stopped menstruating for 12 months, you’re considered to be in menopause. People who have not menstruated for several months but haven’t yet met the 12-month benchmark often refer to themselves as “going through menopause.”

Postmenopause 

This phase begins once you have completed menopause, or gone 12 months without menstruating. You can also categorize menopause by what causes the process to occur. Natural menopause is triggered by your own physical aging processes, while induced menopause is triggered by medical intervention, such as surgery to remove the ovaries or radiation for cancer treatment.

Symptoms

Most of the symptoms you experience with menopause tend to begin during perimenopause and continue as you transition into menopause. 

These symptoms include:

• Changes in menstruation, including shorter or longer periods, irregular bleeding, or spotting
• Hot flashes and night sweats
• Insomnia or difficulty sleeping
• Mood swings
• Loss of bladder control
• Lower sex drive
• Vaginal dryness

When you enter the postmenopause phase, most of your symptoms tend to resolve. However, you may still experience vaginal changes, decreased libido, and bladder control issues from time to time.

Causes

Menopause occurs in people who menstruate. As you get older, your body naturally changes the amount of reproductive hormones you can produce. As a result, you may begin to create less and less estrogen and progesterone (two hormones that regulate the female reproductive system), which can trigger perimenopause. Over time, ovulation stops happening every month and periods become irregular, leading to an eventual end to menstruation altogether. 

The length between perimenopause and menopause varies from person to person. Some may go through the process very quickly (generally in less than one or two years), while others may notice gradual changes to their menstruation over six to eight years. Menopause usually occurs in your late 40s and early 50s, with the average age being 51. 

Risk Factors

Menopause happens to everyone who has a female reproductive system and is a natural aging process in everyone who menstruates. That said, there is no way to lower your risk of undergoing menopause at some point in your life.

However, sometimes menopause can happen much earlier than expected. If you begin menopause before the age of 40, you have what's known as premature menopause. If you undergo menopause between the ages of 40 and 45, you may be going through early menopause.

You might be at an increased risk for premature or early menopause if you:

• Smoke tobacco
• Have a family history of premature or early menopause
• Live with certain health conditions such as autoimmune disorders or chronic fatigue syndrome
• Receive treatment for cancers, such as medication, radiation, or chemotherapy
• Get surgery to remove your ovaries or uterus

Diagnosis

If you’re of typical age to be experiencing menopause and you’re having one or more menopause symptoms, you likely don't need an official diagnosis for menopause. However, a diagnosis might be necessary if you're having symptoms earlier than expected. In such cases, it's a good idea to see your primary healthcare provider or gynecologist (a doctor who specializes in the female reproductive system) for testing.

During your appointment, your provider may run some tests to understand why symptoms are occurring. These diagnostic measures may test you for:

• Follicle-stimulating hormone (FSH): A hormone that helps control your menstrual cycle and grow eggs in your ovaries
• Luteinizing hormone (LH): A hormone that helps regulate ovulation and prepares your body for pregnancy
• Estradiol: A hormone that sustains the function of the reproductive system

If your estradiol levels are lower than normal, or if your FSH and/or LH levels are higher than normal, your provider may determine that you have early or premature menopause. 

Treatment

The goal of treatment during menopause is to make the transition more comfortable and reduce any associated symptoms. That said, there are several treatments available to meet those two goals, including hormone therapy, medications, and natural remedies.

Hormone Therapy

Hormone replacement therapy (HRT) or menopausal hormone therapy (MHT) is a common treatment for reducing menopause symptoms. Generally, this involves taking estrogen, progestin, or a combination of the two hormones. This can come in the form of an oral pill, injection, gel, patch, or vaginal ring.

Getting hormone therapy can relieve some symptoms (e.g., hot flashes and vaginal pain). However, hormone therapy isn't for everyone and may increase your risk of heart disease, stroke, breast cancer, and blood clots. If you are interested in this type of therapy, your healthcare provider is best suited to answer your questions.

Non-Hormonal Prescription Drugs

There are many different types of non-hormonal prescription medications that you can also use to relieve menopause symptoms. Your healthcare provider can help you decide which one is best for you. Options for medications may include:

Natural Treatments

In addition to prescription treatments, research shows that a few dietary supplements can help relieve menopause symptoms. These supplements include black cohosh and ginseng. However, it's important to note that you should not try any nutritional supplements without first speaking to your healthcare provider.

How to Prevent Menopause Flares

Most people undergoing menopause start experiencing symptoms during the perimenopause phase. Symptoms usually last until you are officially in postmenopause—or have not had a period in more than 12 months. While you can't always avoid symptoms during menopause, there are some things you can do to improve poor sleep, mood swings, and hot flashes. These remedies include:

• Practicing mindfulness and relaxation techniques
• Reducing tobacco and alcohol use
• Dressing in layers that are easily removable
• Keeping your bedroom cool at night
• Limiting caffeine
• Exercising most days of the week
• Eating plenty of nutrient-rich foods, especially foods high in vitamin D and calcium

Complications 

People experiencing menopause are at a higher risk of certain other health conditions, like osteoporosis—which is due to your body's decreased estrogen production. While you can’t prevent menopause, you can work with your provider to treat your symptoms and manage your health in an effort to avoid the following complications:

• Osteoporosis: Estrogen strengthens your bone mass, so as estrogen drops, bones become more fragile and prone to breakage. 
• Heart disease: Estrogen helps keep your heart arteries (blood vessels) open and supports the pumping of your blood. As estrogen decreases, the risk of higher levels of low-density lipoprotein (LDL) cholesterol (also known as the "bad" cholesterol) rises. As a result, the risk of heart disease also increases.
• Stroke: Similar to the increased risk of heart disease, estrogen’s effect on blood vessels can also affect your brain. As your blood vessels work with less estrogen, they can constrict and cause your risk of stroke to rise.

Living With Menopause  

Menopause is a temporary condition that isn’t typically dangerous and will progress to postmenopause on its own. However, going through this transition can be frustrating to live with—especially if you experience perimenopause for several years. 

Treating your menopausal symptoms can go a long way toward making your menopausal years pass by a little more smoothly. Talk to your provider if your symptoms are affecting your relationships, mood, or overall quality of life. Not only can they help you get the treatment you need but also refer you to a mental health professional that can support you emotionally as you undergo menopause.